Discussions that mention morphine

Pain Management board


Hey Dub, AIt certainly sounds like you have been through the ringer. Gp's and PM's giving surgical opinions or treating problems utside their specialty is justy a pet peve of mine, Partly from bad experiences where Gp's and the radiologist they use don't even detect broken hardware and some other defects and partly because it's simply crossing the line and giving an opinion in an area that's not their specialty. If youi have a blown disc , that's releasing fragmants and impinging outlets, all the interventional procedures won't fix what needs to be surgically fixed.

A surgeon will look at an MRI or diagnsotic and make his own determination for the need for surgery, regardless of what the GP or PM doc has said. He's the one that goes in and sees exactly what the effects of haveing a nerve entraped by a disc fragment or the effect of bone grinding on bone when diiscs completely collapse. Regardless of what someone from another specialty may think, their opinion rregarding surgery is just that, their opinion. There is no such thing as being to young to have damaged your spine servely enough to need surgery. The reverse is also true, if a GP looks at a diagnostic finding and says you need to have surgery right away, if the surgeon doesn't agree, you wouldn't be having surgery. Another docs opinion from a different specialty, or no specialty at all carries no weight with a surgeon when determining the need for surgery. You age has little to do with it other than actually increasing your odds of having a positive outcome the younger you are, the more you have to lose and your drive to work to get better during recovery. This is where being young is a benefit. I was 27 when I had my first surgery, it wan't a situation where a PM doc or GP opinion really mattered at all once you loose control of your bowels or and blasdder. Fortunately surgery did relieve those problems and did relieve the leg pain although the fusions did fail and left my back a mess. But back pain does respond to pain treatments much better than nerve pain.

As far as your question about something stronger than Norco or lortab 10, the next step up is oxyCodone,wehter it's 5, 7.5 or 10 mg percocet or 5, 15 or 30 mg oxycodone tablets. Oxy is probably closest to hydro in the side effects it causes, the keto synthetic opiates, Hydrocodone oxycodone, hydromorphione and oxymorphone pretty much have the same side efect profile, they tend to be more stimulating then drugs in the morphine class or drugs like methadone. If droswiness is a problem, It's not likely stepping up to oxycdone is going to cause signifacantly more drowsiness. The drowsiness from morphine is usually the most discouraging side effect but most docs suggest you try to get passed the initial newness of the med and that side effect does deminish long before the pain relief deminishes from tolerance.

Hopefully your onth right track and they have some definitive answers from the disco. I would still sugest getting a second opinion, not necesassrily about the need for surgery if the disco indicates it, , but the technique and aproach used to corect the problem. ADR's ahve been aproved for les than 2 years in the US. Unless you hapened to find a surgeon that took part in the decade of clinical trials and has done hundreds of ADRs' , when something like that is aproved, docs can learn the technique in a weekend and go off on their own and start implanting AD's. Personally I done the guinea pig thing enough times and don't want to by a surgeons 6th or 20th ADR. if they have only been doing them 18 months. As far as fusions, there are som many variations in techniques, that's why you want to get a second opinion if the doc is leaning in that direction. Fisons can be done from the back :posterior" with screws and rods and their choice of harvested bone, Cadavor bone, both crushed up and mixed with bone growth enzymes, or fusions can be done from an anterior aproach where they go in from the front and remove the disc completely and replace the disc with 2 vented cylynders that are packed with bone and the growth enzyme called BMP2. There are advantages and disadvantages of both aproaches, So the question to ask is why this aproach and why it's beter than one of the many others. Why this type of hardware versus the other options.

It's not an insult to the surgeon to want another surgical opinion. You are talking about your life and the outcome may greatly efect your future, whether it's positive or neagative. Simply wanting to know why a doc would choose an apoterior aproach Vs an anterior aproach to fusion is a valid question. From the docs POV, they normally learn a specific technique during their residency or fellowship and tend to stick with one or the other throughout their practice.

There are reasons why an anterior aproach to fuse L5 to the sacrum makes more mechanical sense, but it is more invasive. With a doc that does 95% posterior fusions, you may not get all the available info on anterior aproaches and why it may be a better opotion if the surgeon you happen to see simply prefers a posterior aproach. There is also a global fusion, where they use both posterior screws and rods in the back and implanrted cages from the front.

There's no point into getting into it all now. But if you could see all the different types of hardware and each specifc benefit from each design, it makes you wonder how do they choose or are they just using the hardware they are used to and technique they learned years ago. If you get bored, Spine Universe is a great site to look at all the different rigs and available options in hardware and the different aproaches to fusing and the benefit of each.

So good luck with the PM for now and hopefully there is a a more permanent solution down the road with corretive surgery.

Take care, Dave